Transcript Pharmacology and the Nursing Process, 4th ed. Lilley

CHAPTER 45
Immunosuppressant Drugs
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Immune System
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Defends the body against invading
pathogens, foreign antigens, and its own cells
that become cancerous
Can also sometimes attack itself, causing
“autoimmune diseases” or immune-mediated
diseases
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Immune System (cont’d)
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Participates in anaphylactic reactions
Responsible for rejection of kidney, liver, and
heart transplants
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Immunosuppressants
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Drugs that decrease or prevent an immune
response, thus suppressing the immune
system
Used to prevent or treat rejection of
transplanted organs
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Immunosuppressants (cont’d)
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All suppress certain T-lymphocyte cell lines,
thus preventing their involvement in the
immune response
Results in a pharmacologically
immunocompromised state
Mechanisms of action vary according to drug
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Immunosuppressants (cont’d)
 Corticosteroids
 cyclosporine
(Sandimmune)
 azathioprine (Imuran)
 muromonab-CD3 (Orthoclone)
 daclizumab (Zenapax)
 sirolimus (Rapamune)
 basiliximab (Simulect)
 glatiramer acetate (Copaxone)
 tacrolimus (Prograf)
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Immunosuppressants (cont’d)
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Indications vary from drug to drug
Primarily indicated for the prevention of organ
rejection
Some also used for immunologic diseases
such as rheumatoid arthritis and multiple
sclerosis
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Immunosuppressants (cont’d)

Muromonab-CD3 is the only drug indicated
for reversal of organ rejection once rejection
of a transplanted organ has started
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Immunosuppressants (cont’d)
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azathioprine (Imuran)
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Used as an adjunct medication to prevent
rejection of kidney transplants
Also used in the treatment of rheumatoid arthritis
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Immunosuppressants (cont’d)
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cyclosporine (Sandimmune)
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Primary drug used for the prevention of kidney,
liver, heart, and bone marrow transplant rejection
May be used for other autoimmune disorders
tacrolimus (Prograf)
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Used only for the prevention of liver transplant
rejection
Others uses are unlabeled uses
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Immunosuppressants (cont’d)
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glatiramer acetate (Copaxome)
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The only immunosuppressant drug used for the
treatment of multiple sclerosis (MS)
Used to reduce the frequency of MS relapses
(exacerbations) in relapsing-remitting multiple
sclerosis (RRMS)
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Immunosuppressants (cont’d)
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Adverse effects vary according to drugs and
may be devastating
All immunosuppressed patients have a
heightened susceptibility to opportunistic
infections
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Nursing Implications
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Perform a thorough assessment before
administering these drugs
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Renal, liver, and cardiovascular function studies
 CNS baseline function
 Respiratory assessment
 Baseline vital signs
 Baseline laboratory studies, including hemoglobin,
hematocrit, WBC, and platelet counts
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Nursing Implications (cont’d)
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Assess for contraindications, drug allergies,
and drug interactions
Monitor WBC counts throughout therapy; if
the count drops below 3000/mm3, discontinue
the drug, but only after contacting the
physician
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Nursing Implications (cont’d)
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Oral immunosuppressants should be taken
with food to minimize GI upset
Oral forms are used when possible to
decrease the risk of infection that may occur
with parenteral injections
Note that there are several possible drug
interactions
Grapefruit juice also interacts with some of
these drugs
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Nursing Implications (cont’d)
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Oral antifungal drugs are usually given with
these drugs to treat oral candidiasis that may
occur
Observe the oral cavity often for white
patches on the tongue, mucous membranes,
and oral pharynx
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Nursing Implications (cont’d)
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Mix oral cyclosporine solution in a glass
container
Do not use Styrofoam containers because the
drug adheres to the inside wall of the
container
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Nursing Implications (cont’d)
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Follow guidelines for parenteral
administration carefully
Inform patients that lifelong therapy with
immunosuppressants is indicated with organ
transplantation
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Nursing Implications (cont’d)
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Patients taking immunosuppressants should
be encouraged to take measures to reduce
the risk of infection
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Avoiding crowds
Avoiding people with colds or other infections
Inform patients to immediately report fever,
sore throat, chills, joint pain, fatigue, or other
signs of a severe infection
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Nursing Implications (cont’d)
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Monitor for therapeutic responses
Monitor for adverse effects and signs of drug
toxicity
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